10090194 CITY OF CUPERT]:NO BUILDING PERMIT
BUILDING ADDRESS: 20273 NORTHCOVE SQ CONTRACTOR:FUNG MICHAEL G PERMIT NO: 10090194
OWNER'S NAME: FUNG MICHAEL G 12585 MIRA LOMA WAY DATE ISSUED:09/20/2010
IER'S PHONE: 6502197210 LOS ALTOS HILLS,CA 940244710 PHONE NO:
❑ LICENSED CONTRACTOR'S DECLARATION BUILDING PERMIT INFO: BLDG r- ELECT r- PLUMB r
License Class Lic.#
MECH r RESIDENTIAL F COMMERCIAL
Contractor Date
I hereby affirm that I am licensed under the provisions of Chapter 9 JOB DESCRIPTION:REPLACE 2 PATIO DOORS(LIVING/DINING ROOM)LIKE
(commencing with Section 7000)of Division 3 of the Business&Professions FOR
LIKE;NO STRUCTURAL
Code and that my license is in full force and effect.
I hereby affirm under penalty of perjury one of the following two declarations
I have and will maintain a certificate of consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the work for which this permit is issued.
I have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this Sq.Ft Floor Area: Valuation:$1000
permit is issued.
APPLICANT CERTIFICATION APN Number:31641041.00 Occupancy Type:
I certify that I have read this application and state that the above information is
correct.I agree to comply with all city and county ordinances and state laws relating
to building construction,and hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save PERMIT EXPIRES IF WORK IS NOT STARTED
indemnify and keep harmless the City of Cupertino against liabilities,judgments, WITHIN 180 DAYS OF PERMIT ISSUANCE OR
costs,and expenses which may accrue against said City in consequence of the
granting of this permit. Additionally,the applicant understands and will comply 180 DAYS FROM LAST CALLED INSPECTION.
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. --7 -----�
Issued by:----
y:— —_' Date:
Signature Date a
OWNER-BUILDER DECLARATION
RE-ROOFS:
I hereby affirm that I am exempt from the Contractor's License Law for one A All roofs shall be inspected prior to any roofing material being installed.If a roof is
the following two reasons: installed without first obtaining an inspection,I agree to remove all new materials for
I,as owner of the property,or my employees with wages as their sole compensatic n, inspection.
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Signature of Applicant: Date:
Business&Professions Code)
I,as owner of the property,am exclusively contracting with licensed contractors tc
construct the project(Sec.7044,Business&Professions Code). Mir ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I hereby affirm under penalty of perjury one of the following three
declarations: HAZARDOUS MATERIALS DISCLOSURE
I have and will maintain a Certificate of Consent to self-insure for Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the I have read the hazardous materials requirements under Chapter 6.95 of the
performance of the work for which this permit is issued. California Health&Safety Code,Sections 25505,25533,and 25534. I will maintain
I have and will maintain Worker's Compensation Insurance,as provided for by compliance with the Cupertino Municipal Code,Chapter 9.12 and the Health&
Safety Code,Section 25532(a)should I store or handle hazardous material.
Section 3700 of the Labor Code,for the performance of the work for which this Additionally,should I use equipment or devices which emit hazardous air
permit is issued. contaminants as defined by the Bay Area Air Quality Management District I will
I certify that in the performance of the work for which this permit is issued,I shall maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
not employ any person in any manner so as to become subject to the Worker's Health&Safety Code,Sections 25505,25533,and 25534.
Compensation laws of California. If,after making this certificate of exemption,I
become subject to the Worker's Compensation provisions of the Labor Code,I mi ist wn a qr aut�oriz g nt: �� I
Date: t
forthwith comply with such provisions or this permit shall be deemed revoked.
"yL CONSTRUCTION LENDING AGENCY
APPLICANT CERTIFICATION
I certify that I have read this application and state that the above information is I hereby affinn that there is a construction lending agency for the performance of work's
correct.I agree to comply with all city and county ordinances and state laws relating for which this permit is issued(Sec.3097,Civ C.)
to building construction,and hereby authorize representatives of this city to enter Lender's Name
upon the above mentioned property for inspection purposes.(We)agree to save
unify and keep harmless the City of Cupertino against liabilities,judgments, Lender's Address
,and expenses which may accrue against said City in consequence of the
granting of this permit.Additionally,the applicant understands and will comply ARCHITECT'S DECLARATION
with all non-point source regulations per the Cupertino Municipal Code,Section
9.18. u '� I understand my plans shall be used as public records.
�G
Signature"�" Date L O Licensed Professional
CITY OF CUPERTINO
3 ITEMS OF 3 PERM[T RECEIPT OPERATOR: patg
COPY # 1
Sec: Twp: Rng: Sub: B1k: Lot:
APN 31641041 . 00
DATE ISSUED. . . . . . . : 09/20/2010
RECEIPT #. . . . . . . . . BS000011512
REFERENCE ID # . . . : 10090194
SITE ADDRESS 20273 NORTHCOVE SQ
SUBDIVISION . . . . . . .
CITY . . . . . . . . . . . . . . CUPERTINO
IMPACT AREA . . . . . .
OWNER FUNG MICHAEL G
ADDRESS 12585 MIRA LOMA WAY
CITY/STATE/ZIP . . . : LOS ALTOS HILLS, CA 94024-4710
RECEIVED FROM . . . . : NICHAEL G FUNG
CONTRACTOR LIC # *OWNER*
COMPANY . . . . . . . . . . : FUNG MICHAEL G
ADDRESS 12585 MIRA LOMA WAY
CITY/STATE/ZIP . . . : IOS ALTOS HILLS, CA 94024-4710
TELEPHONE . . . . . . . . .
FEE ID UNIT QUANTITY AMOUNT PD-TO-DT THIS REC NEW BAL
---------- ------------- ---------- ---------- ---------- ---------- -
1BCBSC VALUATION 1, 000 . 00 1.00 0. 00 1 . 00 0 .00
1BSEISMICR VALUATION 1, 000. 00 0 .50 0 .00 0 .50 0 . 00
1WINREP EACH 8 2 . 00 380 . 00 0. 00 380 . 00 0 .00
---------- ---------- ---------- ----------
TOTAL PERMIT 381 .50 0 .00 381.50 0 .00
METHOD OF PAYMENT AMOUNT REFERENCE NUMBER
----------------- ---------------• --------------------
CREDIT CARD 381.50 VISA
----------------
TOTAL RECEIPT 381.50
M.Indoer Ar Quailty an mtshe5 ';• „
1.Use Low/No-VOC Paint
2.Use Low VOC,Water-Based Wood Finishes 1 IAQ/Health Pts y=yes
21AQ/Health is 2s
3.Use Low/No VOC Adhesives P Y=Y p
4.Use Salvaged Materials for Interior Finishes 3 IAQ/Health pts y=yes
3 Resource is es
5.Use Engineered Sheet Goods with no added Urea p y=y
Formaldehyde .
B.Use Exterior Grade Ply►r000d for Interior Uses 6 IAQMealth pts y=yes
11AQ/Health is es 0
7.Seedall E�osed P;irtioleboard or MDF p Y=Y p
B.Use FSC Certified Materials for Interior Finish4 IAQ/Health is = es
9.Use F 4 Resource pts y=yesnger-Jointed or Trim D
10.Install Whole House Vacuum System 1 Resource pts yga5 p
3 IAQ/Health pts y=yes
' 0
N.Flooring
1.Select FSC Certified Wood Flooring
2:Use Rapidly Ranewal�le Flooring Materials B Resource pts y=yes
3.Use Recycled Content Ceramic Tiles 4 Resource pts y=yeS p
4.Install Natural Linoleum in Place of Vinyl 4 Resource pts y=yes p
5.Use Exposed Concrete as Finished Floor 5 IAQ/Health pts Y--yes
is
6.Install Recycled Content Carpet with Low VOCs 4 Resource P Y-yeS p
4 Resource pts y_yes p
Total Points Available:
57
Total Points Project Received: 1401 130
0 O"10
v�1
G:datefproWgres ibuilcfngguidelines/ramodelersfgreenpointsfinaip-iamprnterted xls
CITY OF C'UPERTINO
FEE ESTIMATOR- BUILDING DIVISION
DATE: REVIEWED BY:
ADDRESS: *VALUATION: $1,000
APN: BP#:
*PERMIT TYPE: Building Permit PLAT CHECK TYPE: Alteration /Addition / Repair
PENTAMATION 1 GENRES
PERMIT TYPE:
PRIMARY SFD or Duplex hf gar»��rh, ���
USE:
WORK
SCOPE
EM
1'c rrm; VcufJr,e; tsl;fls�?
Li
f,fcY. '1'; 3, J'CC
NOTE: These fees are based on the relimina in ormatioti available and are on l an estimate. CMISC ITEMSor addn'1 in o.
FEE ITEMS gree Resolutio'7 09-051 Ef ''1'10) FIE QTY/FEE
$0.00 2 # Window/Sliding Glass Door
Plan Check Fee: Replacement
Suppl.PC Fee: (F) Reg. � OT 0.0 hrs $0.00 $380.00 1 WINREP p
$0.00
PME Plan Check:
$0.00
Permit Fee:
Suppl. Insp.Fee4E) Reg. 0 OT 0.0 hrs $0.00
PME Unit Fee: $0.00
Fee: $0.00
PME Permit
C-`e�tzstf'trc'rio�r T1.� Q
Acoustical Fee:
Yes C!) No $0.00 0
Work Without Permit? 0 Yes (F) No $0.00
$0.00
Select a Non-Residential
Plannin-y Fee: Building or Structure
rr Ln°t°� Ikxrutfz'rTftrtir>rf 1'<.rt'a'.
Select an Administrative Item
Strona,Motion l'ee:
IBSEISMICR $0.50
Bld Stds Commission Fee:
IBCBSC $1.00
SUBTOTALS: $1.50 $380.00
TOTAL FEE: $381.50
Revised: 9/14/2010
NORTHPOINT HOMEOWNERSASSOCIATION
PROPERTY MOD
Please indicate below which modification(s) are planned for your property. Provide
brochure(s) if possible and a copy of any proposal(s), including the contractor's
license number. Any modification not expres!31y listed herein, or not conforming to
the restrictions and requirements listed herein for that modification will require an
Architectural Review Application to be submitted to the Grounds and Architectural
Committee and the Board of Directors for approval.
ovaSatellite Dish installation has a
separate form to be completed and submittedapproval.
Modification Restrictions and Requirements
Air, conditioning unit Unit will be designed for quiet
residential use. Unit will be
located within the enclosed yard
of the property. There will be no
part of the unit visible to common
areas. installed by a licensed
contractor.
Replacement window/ Must be same size aperture and
Sliding door location of existing window or sliding
door. Any necessary touch-up
r` painting is the responsibility of the
L a n/t y Homeowner. Installed by a license ,v
contractor. ��
Garage door Must be windowless and in confb -ty
with general architectural style of the
complex. Repainting to conform to
exterior color scheme is responsibility
of the Homeowner. Installed by a
licensed contractor.
Any g y adamages caused to property a result of modifications will be the homeowner's responsibility. All prohibitions, restrictions, conditions, and rights of the Association
enumerated under Article V of the amended and restated Covenants, Conditions and
the Northpoint Homeowners Association are applicable to modifications���-S
Restrictions of p
Contained herein. City permits may be requireJ. .
Please Pn.
Homeowners Name(s): M� '
Property Address: t=�`u — Phone:-- -----Phone:
_
Date of Notification: �25� -��X t L'' Date of Completion:
Homeowner has 6 months to complete the dw-ignated modifications and is responsible for
notif)ring management upon project completion.
4�� O c U.-;e O�
Notification received by: Date: -�
Completion verified & a®roved by-._ Date:
Farm adopted 8/10/1999 Revised 5/00
C.1
---------------------
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OWNER-BUILDER DISCLOSURE FORM
COMMUNITY DEVELOPMENT DEPARTMENT•BUILDING DIVISION
10300 TORRE AVENUE•CUPERTINO, CA 95014-3255
CUPERTINO (408)777-3228-FAX(408)777-3333-t uilding(a cupertino.orq
Dear Property Owner(s):
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at:
SITE ADDRESS202�3 /�)C APN BP#
0141NER N�FO� A S P—i
1
DESCRIPTION OF WORK: PEV .Ibti S(7 S ( �-
We are providing you with an Owner-Builder AcknowledgrT ent and Information Verification Form to make you aware of
your responsibilities and possible risk you may incur by having this permit issued in your name as the Owner-Builder. We
will not issue a building permit until you have read, inil:ialed your understanding of each provision, signed, and
returned this form to us at our official address indicated. An agent of the owner cannot execute this notice unless
you,the property owner, obtain the prior approval of the pE rmitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION(IF INFORMATION
(DIRECTIONS:Please read and initial each statement below to signify you understand or verify this information.)
1. 1 understand a frequent practice of unlicensed persons is to have the property owner obtain an"Owner-
Builder'building permit that erroneously implies that tl-a property owner is providing his or her own labor and material
personally. I, as an Owner-Builder, may be held liable and subject to serious financial risk for any injuries sustained by
an unlicensed person and his or her employees while Norking on my property. My homeowner's insurance may not
provide coverage for those injuries. I am willfully acting as an Owner-Builder and am aware of the limits of my
insurance coverage for injuries to workers on my prop,;rty.
n"Ld-- 2. 1 understand building permits are not required :o be signed by property owners unless they are responsible for
the construction and are not hiring a licensed Contractor to assume this responsibility.
,W�F 3. 1 understand as an"Owner-Builder' I am the rE sponsible party of record on the permit. I understand that I may
protect myself from potential financial risk by hiring a I censed Contractor and having the permit filed in his or her
name instead of my own.
r1(.�- 4. 1 understand Contractors are required by law t)be licensed and bonded in California and to list their license
numbers on permits and contracts.
wc.° 5. 1 understand if I employ or otherwise engage E ny persons, other than California licensed Contractors, and the
total value of my construction is at least five hundred dollars($500), including labor and materials, I may be
considered an"employer' under state and federal law.
M4- 6. 1 understand if I am considered an"employer"under state and federal law, I must register with the state and
federal government,withhold payroll taxes, provide w)rkers' compensation disability insurance, and contribute to
unemployment compensation for each"employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
W .r 7. 1 understand under California Contractors' State License Law, an Owner-Builder who builds single-family
residential structures cannot legally build them with tl-e intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the work
is performed under contract with a licensed general b jilding Contractor.
rv1 � 8. 1 understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any sul)sequent owner(s)that result from any latent construction
defects in the workmanship or materials.
OwnerBuilderForm 2010.doc revised 04114110
from the Internal
obtain more information regariing my obligations as an'employer"
yh �9 9. I understand I may the California Department of Benefit Payments,
11 may contact the California Contractors' State
Revenue Seryice, Division eof Industrial a Accidents. I a sates Sma onanderstangov for more information about licensed
and the Californiaor ww v.cslb.ca g
License Board(CSLB)at 1-800-321-CSLB (2752)
contractors. name, and understand that
g permit a lied for in my
used construction activity at the site address listed above.
l��r 10. I am aware of and consent to an Owner-Builder buildin p P ty
am the party legally and financially responsible for prop
the art legally and financially responsible for this prop
as eosed mployers. activity, I will abide
fY) 11.I agree that,as party
by all applicable laws and requirements that govern Owner-Builders as we o any of the
contractors are regulated by laws designed to protect the public. If
�
4((-- 12. I agree to notify the issuer of this form immediately of any additions, or changes the unable to
9may
information I have provided on this form. Licensed c against unlicensed
as a result of a complaint.Your only remedy g
you contract with someone who does not have acense,the Contractors' State License Boar Contractor or
y financial loss you may sustain
assist you with any important fo�you to understand that if an unlicensed
held liable for damages. If
Contractors may be in civil court. It is also imp propertyyou may
employ responsible for verifying whether or not
employee of that individual or Builder and wishm is injured hire Cont actors you I be
you obtain a permit as Ow compensation insurance coverage.
those Contractors are properly licensed and the status of their workers' comp
CONSTRUCTION LENDING AGENCY
(DIRECTIONS:Please complete the following constructio l lending agency information.
f the work for which this permit is issued
I hereby affirm that there is a
construction lending agency for the performance o
(Sec 3097 Civ.)
Lender Address:
Lender Name: the property owner and
permit can be issued,this form must be completed and signed by
Before a building p E rmit. Note:A copy of the property owner's driver's license,
enc responsible for issuing the p : resented when the permit is issued
returned to the agency Y be required to be p
form notarization, or other verification acceptable to the city may Date: ( J
to veri the roe owner's si nature
Property Owner's Signature:
leted b the property
owner only when designating an
- ------------------------ -- ----- .s required to be comp ----------------
-------------------------------------------
- ---y-
(NOTE: The followin owner rization app 0-a is req
agent of the property I for a construction hermit for the Owner-Builder).
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
onsibili I hereby
Owner,the execution of which I understand is my personal resp ry' to obtain an
Excluding the Notice to Property
to act as my agent(s)to apply for, sign, and file the documents necessary
authorize the following p
Owner-Builder Permit for my project.
Scope of Construction Project(or Description of Work):
Project Location or Address: Tel No
Name of Authorized Agent:
Address of Authorized Agent:
that I am the property owner for the addressowner's dryer's Iicense,above and l oerm notarization, orother
I declare under penalty of perjury Note:A cc of the property ow owner's
to the city maybe required to �e presented when the permit is issued to verify the property
above information and certify its accuracy.
verification acceptable
signature. Date:
Property Owner's Signature:
pwnerBuilderFol-m_2010.doc revised 04/14/10
- ` CITY OF CUPERTINO
CUPEKINO GENERAL BUILDING
PERMIT APP'J:JICATION FORM
APN# � 9 � 4 ( ISO
D te:
Building Address: Z� 3 ND,��� �� S� � ri —Pl
Mailing Address (if different from building address):
Are Hazardous Materials being used as part of this project? Yes L No
HOA: (Exterior work only) Yes [�' No ❑ if yes, provide letter from HOA
Owner's Name: Phone#:
MIC' ^� ( Sb Z I OD
Contractor: Phone:
est,) Net- Fax:
Contractor License#:
Cupertino Business License#:
Contact: Phone:
Fax:
Residential Commercial
Job Description: L L. jT : ptt)rUq DO D[ZS
Building Permit Info:
Bldg Elect ❑ Plumb ❑ Mech 11
Type of Construction (Usage Class): Occu ancy Type:
1-A, 1-B ❑ II/IIW-A ❑ II/III B, IV-HT, "NT-B
Valuation: Square Footage:
Project Size: Express Standard ❑ Large ❑ Major ❑
Green Building: Please complete relevant porticn of the Green Bui ding/LEED Checklist & attach it
to the application or if applica)le, include in plan set & the sheet index.
'oints Achieved:
For help, contact Build it Green at www.bu:UditiTeen.org
Revised 07/14/09
3